Thursday, June 30, 2011

Docs turn baby girls into boys - Hindustan Times

I often cringe when I read articles on medical topics in the newspaper. It seems that reporters are out to grab eyeballs by creating sensational headlines - often at the expense of distorting the truth.

An excellent example is the recent series of front page articles run by the Hindustan Times, which talk about how surgeons in Indore are "turning girls into boys" . The reporter has not bothered to check the facts. A simple google search would have helped the reporter to understand what was happening. Sadly, rather than do this, the reporter has published a series of unverified statements, which have now been reproduced all over the web, adding to the confusion.

Admittedly, this is a very complex topic, which most doctors do not understand well themselves, because of all the nuances involved. Some babies are born with what are called ambiguous genitalia, which means their external genitalia are not clearly male or female. In these cases, ( which pediatricians treat as a medical emergency ) it is essential that prompt diagnosis and gender assignment be made, so the child can lead a healthy life in the future. There are entire medical textbooks written on this complex disorder; and a team of doctors ( including pediatricians, geneticists, endocrinologists and pediatric surgeons) are needed to tackle these rare disorders.

Because these conditions are so rare and complex, most doctors will rarely see such babies. These disorders are also called Intersex disorders. The modern term for this now is disorders of sex development (DSDs).

These children are very unfortunate, as are their parents, because it's very difficult for the doctor to decide whether the child is a boy or a girl. Not only is this very distressing, it's often a matter of shame and guilt for the parents ( who often blame themselves whenever a child has a birth defect, because they assume they must have done something wrong to cause their child to be born with such a problem). In some cases, the right diagnosis is only made when the child reaches puberty, because the secondary sexual characters ( which are produced by the reproductive hormonal surge at this time) do not match the sex assigned to the child at birth.

Fortunately, thanks to modern technology, it's possible to do detailed testing, including genetic testing and imaging studies, which allow us to find out the child's genetic gender; and image the internal organs. It is then possible to decide whether the child should be reared as a boy or a girl; and if surgery is needed, what surgery should be performed; and when . ( Ironically, it's far commoner to perform surgery to " convert " a boy into a girl, because this is much easier to do technically ! )

What's even more upsetting about the entire episode is that no medical society or association in India has bothered to provide the medical facts objectively, so as to clear the confusion . A controversy has been raised in the name of protecting the girl child; and doctors are preferring to keep quiet, so they do not get involved in the controversy. This is a very unhealthy trend - for these unfortunate children; their parents; doctors; and society at large !